Provider Demographics
NPI:1437359098
Name:POTTER, COLLEEN CHIEKO (COTA)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:CHIEKO
Last Name:POTTER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-0088
Mailing Address - Country:US
Mailing Address - Phone:303-498-0641
Mailing Address - Fax:
Practice Address - Street 1:3060 E. BRIDGE STREET
Practice Address - Street 2:LOT 200
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601
Practice Address - Country:US
Practice Address - Phone:303-498-0641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant